Exploration of the Utility of Speckle-Tracking Echocardiography During Mechanical Ventilation and Mechanical Circulatory Support

Abstract

OBJECTIVE: This narrative review aims to discuss the potential applicability of speckle-tracking echocardiography (STE) in patients under mechanical ventilation (MV) and mechanical circulatory support (MCS). Both its benefits and limitations were considered through critical analyses of the current available evidence. DATA SOURCES AND STUDY SELECTION: A literature search was conducted in PubMed and Excerpta Medica Database indexed databases (2012–2021). In addition, the reference lists of all selected studies were manually scanned for further identification of potentially relevant studies. DATA EXTRACTION: The terms “Speckle-Tracking Echocardiography,” “Mechanical Ventilation,” “Mechanical Circulatory Support,” “Extracorporeal Membrane Oxygenation,” “Ventricular Assist Devices,” and “Left Ventricular Unloading Devices” were searched for the identification of relevant articles for narrative synthesis. DATA SYNTHESIS: STE is a well-established post-processing method of analyzing myocardial function, with potentially greater clinical utility than conventional 2D echocardiography. STE has been incorporated into the guideline recommendations for both the diagnostic and prognostic evaluations of myocardial and valvular pathologies. However, the potential of STE application within critical care settings has not yet been fully realized. Its utility in the assessment of patients undergoing MV and MCS is substantial. Specifically, it may serve as an ideal modality in the assessment of subtle changes in cardiac function. In the limited number of studies reviewed, STE was consistently a more sensitive marker of myocardial functional change, compared with traditional markers of 2D and Doppler parameters during changes in MV and MCS. CONCLUSIONS: Although current evidence is extremely limited, STE strain is suggested to be a more sensitive and reproducible parameter of myocardial function than conventional echocardiographic parameters and may have value in the assessment of patients undergoing MV and MCS in critical care settings. Further studies in larger populations are required to elucidate STE’s prognostic capability and its value as a point-of-care tool in guiding clinical practice for subjects under MV and MCS.

Pressure–strain loops unveil haemodynamics behind mechanical circulatory support systems

“…However, echocardiography is still an essential tool to guide clinicians in their decisions. STE strain is a sensitive and reproducible parameter to evaluate myocardial function and could be useful in patients with MCS as well 32 . Results from our analysis suggest that MW analysis is feasible even in the context of MCS.…”

“…STE strain is a sensitive and reproducible parameter to evaluate myocardial function and could be useful in patients with MCS as well. 32 Results from our analysis suggest that MW analysis is feasible even in the context of MCS. Despite requiring post-processing analysis, it is a rapid and easy method to non-invasively assess me- Pressure-strain loops in mechanical circulatory support chanics and energetics not only of the left ventricle but also of the right one.…”

RSV‐induced LV dysfunction, what can be the underlying cause?

“…Abbreviations: ESC, European society of cardiology; ERC, European respiratory council; IVC, inferior vena cava; PA, pulmonary artery; PG, pressure gradient; PR, pulmonary regurge; PW, pulsed wave; RVOT, right ventricular outflow tract obstruction; TR, tricuspid regurge.T A B L E 215 Although not achieving statistical significance, yet PPV could still be considered an additional factor in LV impairment in the studied subjects. Verification of this hypothesis might have needed reassessment of LV mechanics after weaning from positive pressure ventilation.…”

“…Increasing intrathoracic pressure leading to decreased venous return and subsequent reduction of LV filling 15 …”

“…">Pulmonary overdistension leading to shift of the interventricular septum to the left and LV compression. Increasing intrathoracic pressure leading to decreased venous return and subsequent reduction of LV filling 15 …”